Research CPC presentation 27th October 2005: Title: Dependence of Human Forearm Skin Postocclusive Reactive Hyperemia on Occlusion Time Get Bee Yvonne-Tee, Aida Hanum Ghulam Rasool, Ahmad Sukari Halim , Abdul Rashid Abdul Rahman

Introduction Human postocclusive forearm skin reactive hyperemia is not only a

potential means of identifying early signs of cardiovascular diseases, it also can be

used in the assessment of local microvascular response to topically applied

compounds on skin. The method is not fully characterised. In this study, we

investigated the influence of occlusion time on postocclusive forearm skin reactive

hyperemia using laser Doppler fluximetry (LDF).

Methods Twenty healthy male volunteers were studied on three separate days (at

least 24 hours apart) via a randomized design. Volunteers were studied in a supine

position while fasted. Laser Doppler probes were placed on the volar surface of the

antebrachium. In preliminary studies, 3 minutes of upper arm blood flow occlusion at

suprasystolic pressure was found to be the upper limit of tolerability. Subsequently,

volunteers were randomized to receive 1, 2 or 3 minutes occlusion on 3 different

days. Skin blood flux was measured before, during and after occlusion using LDF.

The primary outcome calculated was maximal change in skin blood flux before and

after occlusion, expressed in arbitrary units (AU).

Results Skin blood flux changes (mean±SEM) after 1, 2 and 3 minutes occlusion

period were 15.39±1.27AU, 24.84±1.62AU and 32.14±1.73AU respectively. Using

repeated measures analysis of variance, significant difference (p<0.05) in skin blood

flux changes were revealed between these three occlusion durations, where 3

minutes occlusion produced significantly greater in skin blood flux occlusion change

compared to 1 and 2 minutes.

Conclusion Three minutes occlusion produces the greater postocclusive reactive

hyperemia. It is recommended that studies using postocclusive forearm skin reactive

hyperemia should occlude the forearm for at least 3 minutes.

Keywords: Laser Doppler; Methods; Microvascular; Reactive hyperemia; Skin

Reproducibility of Different Parameters of Postocclusive Reactive Hyperemia at Forearm Skin as Measured With Laser Doppler Fluximetry Get Bee Yvonne-Tee, Aida Hanum Ghulam Rasool, Ahmad Sukari Halim , Abdul Rashid Abdul Rahman

Introduction Postocclusive reactive hyperemia at forearm skin is a commonly used

model for studying microvascular reactivity function, particularly in the assessment of

vascular effect of topically applied pharmacological substances. In this study, we

investigated the reproducibility of several different laser-Doppler derived parameters

in the measurement of postocclusive reactive hyperemia at forearm skin in healthy

subjects.

Methods Eighteen young healthy male volunteers were recruited and studied in a

supine position while fasted. Forearm blood flow was occluded at suprasystolic

pressure for 3 minutes. Microvascular perfusion was measured continuously using

laser Doppler fluximetry. Parameters studied were maximum increase in hyperemia

perfusion (PORHmax), time-to-peak (Tp), amplitude of peak perfusion (PORHpeak),

percentage of hyperemic response (PORH%) and mean velocity of the hyperemia

increase (PORHmax/Tp). Measurement was performed twice within each study day for

2 study days. Coefficient of variation and intraclass correlation coefficient (ICC with

95% confidence interval) were calculated for each parameter. An ICC value above

0.75 was interpreted as “excellent reproducibility”.

Results ICC analysis showed that all studied parameters, except for PORH%,

demonstrated excellent reproducibility for both within- and between-day

measurements. Satisfactory intraday and interday coefficient of variations (<10%)

was also obtained for these parameters.

Conclusion Laser Doppler-derived PORHmax, Tp, PORHpeak and PORHmax/Tp were

highly reproducible parameters for measuring microvascular reactivity during reactive

hyperemia with PORHmax shown as the most reproducible index. PORH% is

however less reproducible. These findings have implications for the use of laser

Doppler fluximetry coupled with 3 minutes occlusion PORHmax as a useful and

reliable noninvasive clinical measurement index of microvascular function.

Keywords: Laser-Doppler; Methods; Microvascular; Parameter; Reactive hyperemia; Skin

Correlation of cancer treatment related fatigue (CTRF) with biochemical and hormonal profile. A prospective study Biswa Mohan Biswal *, N.Kumaraswamy **, Mallik Mumtaz *, Department of Nuclear Medicine, Radiotherapy & Oncology* and Psychiatry**, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia

Summary

Background: Cancer treatment using chemotherapy or radiotherapy results in

considerable cancer fatigue. Fatigue can induce significant stress causing hormonal

alteration through hypothalamic pituitary axis leading to change in the internal milleu.

We evaluated hormonal profile to find out a putative correlation between hormone &

cancer fatigue. Materials & Method: Fifty two histopathology documented cases of

cancer patients were subjected to Pipers Fatigue Score (PFS) and blood test for

hemoglobin level, hormonal and biochemical parameters before and after

radiotherapy and chemotherapy treatment. Routine serum chemistry for liver function

and kidney function tests, hemoglobin level, human growth hormone,

adenocorticotrophic hormone, thyroid stimulating hormone and serum free cortisol

level were evaluated. The individual fatigue scores were compared with respective

parameters. Results: Fifty two cancer patients planned for anticancer therapy

completed initial pretreatment evaluation however post treatment assessment was

not possible in 8 cases as later died during therapy. There were 20 males and 32

females in the study with a median age of 50 years (range15-78 years). The stage

distribution was as stage-I (12%), stage-II (17%), stage-III (44%) and stage-IV

(26%).The primary cancer were in breast (19%), musculoskeletal (9%), head and

neck (19%), gynecological (19%) and miscellaneous sites (14%). The individual

(Piper Fatigue Score) were behavioral severity (26.6%), affective meaning (28%),

sensory (22.2%), cognitive mood (8.8%) and total score (22.2%) respectively. There

were significant rise in the fatigue score following chemotherapy and radiotherapy.

There was no correlation between biochemical or hemoglobin parameters. The

serum human growth hormone and cortisol were positively correlated with fatigue

(Pearson correlation 0.399 and 0.414). Conclusions: Cancer treatment related fatigue

is a multidimensional event that affect stress hormonal milieu. The human growth

hormone and corticotrophins were affected among cancer patients suffering from

fatigue. Probably this finding may help to improve therapeutic intervention.

Title : “In vivo toxicity study of a plant Phyllanthus amarus, in rat”

- Dr. K. N. S. Sirajudeen -

ABSTRACT

Introduction: Phyllanthus amarus (P. amarus), a plant species of Euphorbiaceae

family, is used as a folk medicine for jaundice and other diseases in Malaysia and

other countries. The variation in their efficacy with geographical location and varieties

has been reported which has been attributed to their constituent composition. But, so

far no toxicity studies have been carried out on this plant with clear documentation,

especially with those plants growing in Malaysia.

Objective: The aim of this preliminary study was to determine the toxic side effects

of aqueous extract of leaves of P. amarus (grown in Malaysia) following oral

administration in rats by assessing the morphological, biochemical and histological

changes in them.

Materials & Methods: Sprague-Dawley rats weighing (180-230 grams) were used

as animal models in this study. Aqueous extract of leaves of P. amarus was

administered orally to male rats for acute toxicity study (5 gram / Kg body weight)

and to the male and female rats for chronic toxicity study (at the doses of 100, 400

and 800 mg/ Kg body weight/day for six weeks). Control of male and female rats was

also maintained without plant extract administration. Body weight of the rats was

taken initially and periodically once a week, till the end of experimental period. At the

end of experimental period (6 weeks), the rats were sacrificed and analyzed for

biochemical markers of liver injury - alanine transaminase (ALT), aspartate

transaminase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and

total protein in the serum collected. Liver sections were taken for histological studies;

Light microscopy, proliferative cell nuclear antigen (PCNA) study and apoptotic study

by using ApopTag kit .

Results: Acute admininstration of P. amarus extract, orally, even at a dose of 5

gram/Kg body weight) did not produce any signs of toxicity or mortality. In the chronic

study, no significant differences (p>0.05) were observed between the control and P.

amarus extract administered rats in the body weight gain during the experimental

period as well as in the biochemical markers analyzed (ALT, AST,ALP,LDH and total

protein) in serum. The non-toxic nature of P. amarus extract administration was

confirmed by histological studies i.e., no observable changes were found between

control and P.amarus extract administered rats.

Conclusion: Acute oral administration of P.amarus extract is non-toxic to the rat

liver, even at a dose of 5 gram /kg body weight. The chronic toxicity studies of P.

amarus extracts administration (of 100-800 mg/kg body wt) showed the absence of

cumulative toxicity as reflected by the non-significant change in the parameters

studied as well as from the results of the histological studies.

Key words: Phyllanthus amarus, Aqueous extract, Liver, Toxicity, Marker

enzymes, Histological studies

ACUTE EFFECTS OF AMMONIA ON ‘CITRULLINE-NO CYCLE ENZYMES’, ARGINASE AND RELATED METABOLITES IN DIFFERENT REGIONS OF RAT BRAIN

M. Swamy, Adlin Zafrulan Zakaria, Chandran Govindasamy, K.N.S. Sirajudeen and H.A. Nadiger ABSTRACT: Nitric oxide (NO) is involved in many physiological and pathological processes in the

brain. NO is synthesized from arginine by nitric oxide synthase (NOS) enzymes.

Citrulline, which is formed as a by-product of the NOS reaction, can be recycled to

arginine by successive actions of argininosuccinate synthetase (ASS) and

argininosuccinate lyase (ASL) via the citrulline-NO cycle. Hyperammonemia is known

to cause poorly understood perturbations of the citrulline-NO cycle. Both ASS and

ASL genes are reported to be induced in astrocytes but not in neurons of aggregates

exposed to 5 mM ammonium chloride, suggesting that hyperammonemic brain might

increase its recycling of citrulline to arginine. To understand the role of citrulline-NO

cycle in hyperammonemia, NOS, ASS, ASL and arginase activities, as well as

nitrate/nitrite (NOx), the stable end products of NO, and other related metabolites

were estimated in cerebral cortex (CC), cerebellum (CB) and brain stem (BS) of rats

subjected to acute ammonia toxicity (0.8mmol of ammonium acetate per 100g body

weight). NOx concentration and NOS activity were found to increase in all the regions

of brain in acute ammonia toxicity. The activities of ASS (CC, CB and BS) and ASL

(CC and CB) also showed an increase whereas the activity of arginase was not

changed. The concentrations of arginine and ornithine were increased in all the

regions of brain in acute ammonia toxicity whereas citrulline concentration was not

changed. Glutamine concentration was significantly increased in all regions of brain

while glutamate and GABA concentrations were not changed. The results of this

study clearly demonstrated the increased formation of NO, suggesting the

involvement of NO in the pathophysiology of acute ammonia toxicity. The increased

activities of ASS and ASL enzymes indicate the increased and effective recycling of

citrulline to arginine in acute ammonia toxicity, making NO production more effective

and contributing to its toxic effects.

STUDY ON COMMON SEXUALLY TRANSMITTED DISEASE (STD) INFECTION IN INFERTILE FEMALE IN HOSPITAL UNIVERSITI SAINS MALAYSIA, KUBANG KERIAN KELANTAN. A.Zuky Nik Lah*, N.H. Nik Hussain*, MD. Radzi Johari**, Nordin Senik** Dept. of O&G*. Dept of Microbiology**, Universiti Sains Malaysia, 16500 Kubang Kerian, Kelantan. OBJECTIVES: To determine local prevalence of common organism in STD infection (Chlamydia, Gonorrhoea and Syphilis) in infertile females in HUSM To determine the clearance rate of Chlamydial and Gonorrhoea infection after a course of Azithromycin 1 gram STUDY METHOD: A prospective study involving 150 infertile females under follow

up at infertility clinic HUSM between 1st of March 2002 till 28th of February 2003 .

Endocervical samples were obtained to detect Chlamydia trachomatis by direct

immunofluorescence, Neisseria gonorrhoea by Gram smear and culture&sensitivity.

Blood samples were also obtained for VDRL testing and for Ig M antibody toward

Chlamydia. For VDRL testing positive patient another blood sample for Treponema

pallidum haemagglutination assay (TPHA) will be taken. In a patient with a positive

Chlamydial or Gonorrhoea or both infections, she and her partner will be treated with

a single dose of Azithromycin 1 gram orally. After 2 weeks of Azithromycin, the

respective investigation(s) will be repeated to determine the clearance of such

infection(s).

RESULTS: Chlamydia infection was present in 6 (4.0%) patients.There was no

incidence of gonorrhoea or syphilis infection in the studied population.. All repeated

investigations after Azithromycin for Chlamydial infection showed a negative testing.

The clearance rate of Gonorrhoea or Syphilis is unable to determine as there is no

incidence of the infection in the studied group.

CONCLUSION: The prevalence of Sexually Transmitted Disease

(Chlamydia,Gonorrhoea and Syphilis) infection in infertile female is low in our studied

group. The clearance rate of Chlamydia infection by Azithromycin is good. This is not

a true representation of Malaysian populations as it is a hospital-based study. A

larger scale study involving a few centers is needed in order to obtain a better

representation of Malaysian populations.

A Study on Factors Affecting Newborn Weight and Large for Gestational Age (LGA) Newborns in Non-Diabetic Mothers : The Role of Maternal Serum Triglycerides 1Siti Mariam Sh Ahmad, 1N Hazlina NH, 1Che Anuar CY, 2Faridah AR, 3Shukri 1Department of Obstetrics and Gynaecology, 2Department of Chemical Pathology, School of Medical Sciences, Health Campus, Kubang Kerian , Kelantan and 3School of Civil Engineering, Engineering Campus, Universiti Sains Malaysia, West Malaysia. ABSTRACT Introduction: Triglycerides have been shown to be a biochemical predictor of

newborn weight and risk of large for gestational age (LGA) in a few previous small

studies. The objective of this study is to ascertain whether mid-pregnancy fasting

serum triglycerides can predict the risk of developing LGA and newborn weight in

non-diabetic pregnant mothers.

Methodology: Universal sampling of pregnant mothers attending the antenatal clinic

at the Hospital Universiti Sains Malaysia (HUSM) and nearby clinics between 24 to

32 weeks gestation was carried out between December 2003 and July 2004.

Expectant mothers were screened for exclusion criteria including diabetes,

hypertension, pre-eclampsia, fetal anomaly and multiple gestations. Those who were

sure of dates and consented for the study were enrolled. Modified oral glucose

tolerance test (MOGTT) was performed and fasting serum triglycerides and total

cholesterol were analysed. The subjects were followed up at delivery when the

period of gestation, the birth weight and the sex of newborn were noted. The

correlations of the variables with newborn weight were tested and multiple linear

regressions were used to find the associations. Bivariate logistic regression was used

to look at the association of LGA newborn and the variables including triglycerides

which were divided into two groups. The associations of the two groups of

triglycerides and fasting plasma glucose (FPG) with the incidence of LGA were

tested in cross tabulations.

Results: A total of 310 subjects were enrolled and 267 completed data were

analyzed, 246 were normal glucose tolerant (NGT) and 21 impaired glucose tolerant

(IGT). The incidence of IGT in this study was 7.9%. In NGT, triglycerides correlated

poorly (r=0.14, p=0.03) with newborn weight while maternal body mass index (BMI)

(r=0.30, p<0.001) and FPG (r=0.28, p<0.027) were the only two variables moderately

correlated with newborn weight after adjustment of the gestation and gender of the

newborn. FPG (OR 3, p=0.027), high triglycerides value (>2.78mmol/L) (p=0.039)

and 2 hours postprandial plasma glucose (HPPPG) (p=0.044) were associated with

risk of LGA newborn. With high triglycerides (>2.78mmol/L) and FPG (>4.3mmol/L),

risk of getting LGA was 31.8% (p<0.001).

Conclusions: In NGT subjects, mid-pregnancy high FPG and high triglycerides

value could be used to predict risk of getting LGA newborn.

Keywords: maternal triglycerides, mid-pregnancy, newborn weight, large for

gestational age (LGA)

Research presentation 29/9/05 Title: Detection of BCR/ABL gene in Malay patients diagnosed as leukaemia Dr Rosline Hassan

BCR/ABL gene is a product derived from t(9;22). Its presence confers a diagnostic

and prognostic value for CML and ALL respectively. The aim of this study was to

establish a method in detecting the presence of BCR/ABL fusion gene and to identify

types of breakpoints in leukaemic patients. Forty patients were enrolled into the

study. RNA was extracted from the blood and bone marrow samples and was

subjected to RT-PCR for BCR/ABL gene.

Two of ALL patients (7.1%) and 13 of CML (92.8%)had BCR/ABL fusion gene. In

conclusion BCR/ABL fusion gene was detected in leukaemia patients by using

Multiplex RT-PCR. It should be done routinely in all patients with ALL and CML, as its

presence is useful in the management of patients.

Title : A Study on Chlamydial Infection in Pregnancy in Hospital Kota Bharu.

- Dr. Shah Reza Johan Noor -

Conceptual:

Chlamydia trachomatis infection is the most common curable bacterial infection, and

is now the most common sexually transmitted disease worldwide. World Health

Organisation figures estimated that 89 million new cases of genital chlamydial

infections occurred in 1995, highlighting the worldwide prevalence of infections and

the economic burden on healthcare delivery. For pregnant women, this infection has

been associated with morbidity for both the mother and the newborn.

Objectives:

This study was undertaken with the objectives to determine the prevalence of genital

Chlamydia trachomatis infection in pregnancy among the attendees of Antenatal

Clinic of Hospital Kota Bharu, Kelantan so as to ascertain whether universal

screening is needed or not. The other objective is to observe the effectiveness of

treatment of chlamydial infection with one-week course of erythromycin stearate

500mg qid.

Methodology:

440 pregnant women (age range 17 to 48 years old), in the first to third trimester,

attending the antenatal clinic of Hospital Kota Bharu, Kelantan were tested for

Chlamydia trachomatis. Endocervical swabs were collected for Chlamydia

trachomatis diagnosis by Direct Fluorescence antigen detection(DFA) technique.

Results:

Out of 440 tested women, four were positive, giving the prevalence rate of 0.9%.

There were no statistically differences in the age, gravidity, parity, socioeconomic

status, education level, history of prematurity or stillbirth or abortion between the

positive and negative group. All the four women with positive results were retested

after treatment and all of them were cleared. However, small number of patients

precludes further statistical analysis.

Conclusion:

As the prevalence rate of genital Chlamydia trachomatis infection in antenatal

population of Hospital Kota Bharu is very low, there is no need for universal

screening to detect this infection. However, it might have been different in other parts

of Malaysia. All of the women with positive chlamydial tests were asymptomatic.

Therefore diagnostic testing based on clinical findings is unreliable.

A STUDY ON RISK FACTORS OF REPEATED ADMISSIONS AMONG SCHIZOPHRENIC PATIENTS IN HOSPITAL KOTA BHARU Researchers Dr. Samsul Draman, Dr. Shaiful Bahari Ismail, Dr. Mohd. Raza Merchant Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia

Summary

Introduction: The number of people with psychological problems in the world has

reached 1.5 billion in 1996, but only one percent of them have received treatment

(10th International Psychopathology Conference). Schizophrenia is a difficult disease

that many choose to conceal. Relapse and frequent readmissions among

schizophrenic patients are common and various risk factors have been associated

with them. These further enhance the existing societal stigma which causes pain to

the patients, their family and friends.

Objective: To identify the risk factors of readmission in less than 6 months from the

previous admission among schizophrenic patients in Hospital Kota Bharu.

Methodology: A total of 120 outpatients and 120 inpatients who fulfilled DSM IV

criteria for schizophrenia from Hospital Kota Bharu between 1st October 2002 until

31st March 2003 were interviewed using a validated questionnaire. The questionnaire

includes questions on patients’ sociodemographic data, compliance, insight, family

support and life events.

Results: Using multiple logistic regression, it was shown that young age ( OR: 0.94,

p: 0. 004), number of previous admission (OR: 1.163, p: 0.001), good compliance (

OR: 0.046, p: 0.001), poor insight ( OR: 7.32, p: 0.001), partial insight ( OR: 3.08, p:

0.023), importance of follow up (OR: 2.94, p: 0.043) and family remind follow up (

OR: 0.17, p: 0.001) were significant risk factors of repeated admissions. Other

variables such as marital status, income, education, distance and life events showed

no significant associations.

Conclusions. Age, number of previous hospitalization, poor compliance, poor insight

and poor family support were important factors in determining repeated admissions

among schizophrenic patients. In the management of these patients, good family

supports need to be emphasized.

STUDY ON CHARACTERISTICS OF PATIENTS WITH REPEATED ADMISSIONS FOR ASTHMA IN HOSPITAL TENGKU AMPUAN AFZAN, KUANTAN, PAHANG, MALAYSIA. Researchers Dr. Shaiful Bahari Ismail, Dr. Mohd Aznan Md. Aris, Dr. Fauzi Mohamed Key words: asthma, repeated admission ABSTRACT Objective To determine the characteristics in patients with repeated admissions for

asthma compared to patients with no repeated admission for asthma over the same

period of one-year duration.

Methods A cross-sectional comparative study among 30 patients with asthma who

had repeated admissions and another 30 patients with asthma who had no repeated

admission for exacerbation of asthma over the same period of one-year duration

(2001). The socio-demographic, clinical characteristics and evaluation data were

collected. The evaluation included measurement of peak expiratory flow (PEF),

inhaler technique skills and questionnaires on knowledge of asthma.

Results There was no significant difference in socio-demographic characteristics,

measurement of PEF and inhaler technique skills in both groups. In clinical

characteristics, there was significant difference noted in history of atopy, history of

absenteeism, asthma symptoms and use of medications. There was significant

difference in the knowledge of asthma where the total mean scores was 14.8 in

repeated admissions group and 17.7 in non - repeated admission group from the

total score of 31.

Conclusions Patients with repeated admissions for asthma tend to have high past

history of atopy, high history of absenteeism from work or school, more frequent

nocturnal symptoms and more use of low dose inhaler corticosteroids. They also had

poor inhaler techniques and less asthma knowledge.

Doctor-shopping behaviour amongst ADULT patientS attending Family Medicine Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan. Researchers Dr. NorAsmah Hassan, Dr. Shaiful Bahari Ismail, Dr. Syed Hatim Noor Keywords: doctor-shopping, associated factors Introduction

The term doctor-shopping refers to the changing of doctor without professional

referral in a single episode of illness. Doctor-shopping behaviour has already been

reported in many countries including Hong Kong, Japan and also Malaysia ( Lo A.Y.

et al., 1994, Sato T. et al, 1995, and Sanidah M.A., 1998, unpublished).

Rusli N. et al. (1995) described that majority of outpatient had adopted the second

mode of treatment after an apparent failure of the first mode of therapy, went to

government or private doctors with small proportion seeking traditional healers.

Objective To determine the prevalence and associated factors of doctor-shopping

behaviour amongst adult patients attending Family Medicine Clinic (FMC) Hospital

Universiti Sains Malaysia (HUSM).

Methods It was a cross-sectional study conducted on 442 adult patients aged 18

years and above. It was conducted as face to face interview using questionnaires.

Data were analysed using SPSS version 11.

Results Fifty-six percents of these patients met our criteria for doctor-shopping

patients. Most of the patients went to general practitioners for consultation prior to

FMC visit. One-fifth of the respondents went for alternative treatment for the current

illness episode. The main reason for changing doctors was due to no improvement

of the illness. Doctor-shopping behaviour was found to be significantly associated

with older age group and employed patients. Doctor-shopping patients were found to

be high among married people, females and patients with low education level, but the

associations were not significant. The significant associated factors of doctor-

shopping behaviour were chronic duration of illness, and advice to seek treatment

from somebody.

Conclusion: Prevalence of doctor-shopping behaviour amongst adult patients

attending FMC was high. It is important to recognise and anticipate problems related

to doctor-shopping behaviour. We need to emphasise on the importance of a good

doctor-patient relationship, and give accurate explanation and health education to

maintain a proper continuity of care.

A COMPARATIVE STUDY OF INTRAVENOUS PATIENT CONTROLLED ANALGESIA MORPHINE AND TRAMADOL UNDERGOING MAJOR OPERATION H SHAMSUL KAMALRUJAN, MR A HADI, N M NIK ABDULLAH Department of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia

INTRODUCTION

The success of major surgery depends partly on providing effective post-operative

pain relief, which can be achieved by morphine administration via PCA system.

tramadol is a week opioid analgesic, which act mainly on µ-opioids receptor. The

purpose of this study was to evaluate the effectiveness of intravenous patient –

controlled analgesia (PCA) tramodol in comparison with PCA Morphine in terms of

analgesic properties, sedation and side effects.

METHODS

A randomized, double – blinded study was conduct on one hundred ASA 1 or 11

patients who were divided into two groups by closed technique. Following surgery,

PCA Morphine (M) group (n = 50) received loading dose of intravenous morphine 0.1

mg/ kg followed by PCA bolos of 1 mg (1 mg/ ml) as required. PCA tramadol (T)

group (n = 50) received loading dose of 2.5 mg/ kg of intravenous tramadol followed

by PCA infusion of 10 mg (10 mg/ ml) as required. The lockout intervals for both

group were 10 min and all the patients received no base line infusion. In the

recovery room, patient were given oxygen via facemask and monitored for Modified

Pain Score, Ramsay Sedation score, respiratory rate, nausea, vomiting, pruritus,

blood pressure and pulse Rate. Patients were evaluated at the end of 30 minute in

recovery room, at 2030 H on operative day, 2030 H first postoperative day and at

2030 H second postoperative day in the ward.

RESULTS

Showed no difference in the demographic data between the two groups (p > 0.05). T

group had a pain score of 0.79 ± 040 as compared with M group 0.81 ± 0.54. The

sedation score for T group was 0.40 ± 0.26 as compared to 0.39 ± 0.36 for M group.

There were no significant difference between the two groups with regard to the blood

pressure and heart rate. The incidence of nausea, vomiting and pruritus were the

same between the two groups.

CONCLUSION

This study indicates that PCA tramadol is equally effective as PCA morphine for pain

controlled following major surgery. The incidences of sedation, nausea or pruritus

were the same between the two groups.

Title: Radiation Exposure To The Surgeon During Femoral Interlocking Nailing Under Fluoroscopic Imaging

S Muzaffar, Y Imran , MA Iskandar , A Zakaria

Summary

Femoral interlocking nailing requires fluoroscopic assistance for the insertion of nail

and distal screws. This machine produces ionizing radiation and should not be used

unnecessarily during the procedure. In this study, scattered radiation dose to the eye

and hand of the operating surgeon were measured during femoral interlocking nailing

under fluoroscopic imaging. Thermo luminescent dosimeters (TLD) were used to

quantify the dose received by the surgeon’s hand and eye.

The scattered radiation dose was measured during ten procedures of femoral

interlocking nail. The mean radiation exposure time was 3.89 minutes. Mean

scattered radiation dose to the hand and eye were very low, 0.27 mSv per procedure

and 0.09 mSv per procedure respectively. These finding showed that scattered

radiation received by the operating surgeon during interlocking nail was low. It is very

unlikely for a surgeon to receive more than the recommended annual dose limit set

by the National Council on Radiological Protection.

Title: Patient Satisfaction toward Medical Ward Services in HUSM and HKB Researchers Zamri Md Ali1, Than Winn2, Mohd Ayub Sadiq3, Mazlan Abdullah4, Abd Aziz Baba Mohd5 1 Ministry of health, 2,3,4Department of Community Medicine, 5 Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Summary

Introduction:

Patient satisfaction is a human experience, appraised subjectively by an individual,

regarding the extent to which care received has met certain expectations, underlying

this assumption is a belief in the patient’s basic right to participate in decisions about

clinical care, and recognition of the importance of patients as sources of information

about their own values and preferences. Patient satisfaction is, in essence, a human

judgment.

Areas to cover on the patient satisfaction survey

- Interpersonal aspects of care: perceptions by patient of caregiver interest,

caring, and sensitivity to patient needs; clear and complete communication /

education.

- Practice accessibility, convenience, staff courtesy, office cleanliness, other

operational factors

- Intention to continue/return, to comply with treatment, etc.

Objective:

- To assess the level of patient satisfaction

- To relate patient and admission characteristics with various dimension of

patient satisfaction

- To determine factors associated with items of patient satisfaction of inpatients

admitted to medical wards of HUSM & HKB

Methodology:

Cross-sectional design: a prospective data collection using validated, self-

administered questionnaire. 190 inpatients admitted to medical wards, HUSM and

HKB were interviewed using validated self-administered questionnaire. It

comprised 45 items of satisfaction questions, each scored on 5-point Likert scale.

Item scores under each domain were summed and weighted according to the

number of items and computed as proportions. These newly computed domain

scores were subject to simple linear regression with each patient characteristic.

These scores were also dichotomized into high and low satisfaction groups using

a cut-off point at 80% and the analysis was repeated as simple binary logistic

regression.

Results:

The mean satisfaction scores for the domains Loyalty, Nurse, Doctor, Staff and

Comfort were moderate (>70%) but for low for Miscellaneous and Finance

domains.

Admission diagnosis, Length of stay, Hospital bill, Expense on food , Total

expenditure were significantly associated with satisfaction scores.

The item-wise satisfaction scores for doctors such as introduce themselves,

greeting patients, communicating with patients in explaining treatment

procedures, side effects and importance of compliance etc were low in both

hospitals.

Conclusions.

Hospital administrators in tandem with service providers should try to improve

patient satisfaction through continuous self-evaluation, feedback and

implementation of appropriate recommendations. Examples:

- A multi-media platform allowing patients to make complains or give suggestions

on-line

- A built-in automated compilation, analysis of data and reporting and feed back

to service-providers and consumers

- Starring the hospitals by the consumers (an adjunct to the existing hospital

accreditation)

o all hospitals in Kelantan or Malaysia

o all case-mixes

o all services and service-providers

VALIDATION OF MALAY VERSION SHORT-FORM GERIATRIC DEPRESSION SCALE AND STUDY OF PREVALENCE OF MAJOR DEPRESSION AND ITS ASSOCIATED PSYCHOSOCIAL FACTORS AMONG ELDERLY INPATIENTS AT UNIVERSITI SAINS MALAYSIA HOSPITAL Assoc. Prof. Hasanah Che Ismail

Background: Depression is prevalent among the elderly physically ill inpatients and

has important clinical implications, but often under recognized and under treated.

There is no previous Malaysian data on the prevalence of major depression among

the elderly inpatients.

Objectives: This study aimed to validate the Malay version of the short form

Geriatric Depression Scale (GDS) in order to determine the prevalence of major

depression and its associated psychosocial risk factors among the elderly inpatients

hospitalized for general medical condition.

Methods: The study consisted of 2 stages. First, the validation of the Malay

version-GDS; followed by a cross sectional prevalence study, participated by 271

elderly inpatients. Data were collected using a self-administered questionnaire, the

validated Malay version-GDS and WHOQOL-BREF. Major depression was defined

as score above the optimum cut-off point on Malay version-GDS determined at the

validation study.

Results: The validation study showed the item-9 from Malay version-GDS-15 had

no discriminatory value in differentiating cases and non-cases and poorly correlated

with the total corrected item score. By omitting the item-9, the newly formed scale, M-

GDS-14, has satisfactory reliability and validity as a screening scale for depression

among physically ill elderly inpatients. At the cut off point of 7/8, the M-GDS-14 had

100% sensitivity and 92.0% specificity in detecting major depression.

The overall prevalence for major depression was 37.3%, 25.9% for male and 45.8%

for female. Under multivariable analysis, the female to male odds ratio for major

depression was 2.2 (p = 0.03). Those depended on working as the primary source of

personal income, were at significant higher risk than pension group for major

depression (OR = 7.8). The self-rating of relatively having enough money to meet

needs, satisfactory personal relationship, adequate accessibility to information

needed and opportunity for leisure activities were all significant protective factors

against major depression.

Conclusion: The prevalence yielded in this study was relatively high. Clinician

should be aware of this highly comorbid condition along with patients’ physical

illness. Good social resources play important role in preventing major depression in

the elderly inpatients.

Key Words: Geriatric Depression Scale, prevalence, major depression, elderly,

inpatient, physical illness.

USM Short Term Grant Assoc. Prof. Dr. Kamaliah Mohd Daud Abstract of study entitled “Acute Dialytic Support for the Critically Ill: Continuous Venovenous Haemodialysis versus Continuous Venovenous Haemofiltration”

ABSTRACT

A prospective randomized controlled study was performed to compare the effect of 2

modalities of continuous renal replacement therapy (CRRT) i.e. continuous

venovenous haemofiltration (CVVH) versus continuous venovenous haemodialysis

(CVVHD) on the clinical outcome in critically ill patients with acute renal failure in the

intensive care units in Hospital Selayang and Hospital Kuala Lumpur. Patients’ vital

signs, urine volume and biochemical variables were recorded daily while on

treatment. The duration of CRRT treatment and ICU stay, extent of renal recovery

and survival status at discharge from ICU were also recorded. Serum for cytokines

assay (IL-6 and TNF- �) were taken at 0 hour and 24 hours of CRRT treatment. Over

a period of 28 months (September 2001 till December 2003), a total of 20 patients

were included in the study. Patients’ demographic, clinical features and laboratory

data were comparable between the 2 treatment groups. The increase of TNF- � was

35.6% versus 173.0% and drop in IL-6 was 48.8% versus 18.0% in patients treated

with CVVH and CVVHD respectively. The overall mortality rate was 85%. The

duration of ICU stay, % of complete renal recovery and death rates for CVVH

compared to CVVHD patients were 16.0 days versus 8.0 days (p = 0.16), 11.1%

versus 9.1% (p = 1.0) and 77.7% versus 90.9% (p = 0.57) respectively. In conclusion,

patients treated with CVVH had more favourable changes in cytokines level but the

clinical outcomes were similar between CVVH and CVVHD treated groups.

Thank you

A STUDY ON HYGIENIC STANDARD OF FOOD PREMISES AND MICROBIOLOGICAL QUALITY OF FOOD IN KOTA BHARU Prof. Madya Mohamed Rusli Abdullah/Dr. Zaliha Ismail

The hygienic aspects of food premises are a major concern for public health officers

and inspectors in preventing foodborne illness. A study of the status of hygiene

standard of food premises and microbiological quality of food provided findings on

hygienic standard of food premises in relation to microbiological quality of food for

further analysis of sources of food contamination. A cross sectional study of 362 food

premises in the area under the Municipal Jurisdiction of Kota Bharu were randomised

and evaluated for hygienic aspects based on standardized form used by the District

Health Office. Staple and snack / kuih groups of food were selected at the time of

premises evaluation which then analysed for total plate count (CFU/gm), coliform

count (MPN/ml) and E. coli (MPN/ml). It was found that 21.8 % (79) of selected

premises had a score of less than 50 with a mean 44.40 ± 4.0, which considered as

unsatisfactory. Results of microbiological analysis of food samples showed that

34.08% of sample had unsatisfactory in total plate count, 47.8% in coliform count and

24.7% in E. coli count. E. coli count was detected more in staple foods as compared

to snacks/ kuih. There was a significant difference of the satisfactory levels of

microbiological analysis amongst different groups of food (P<0.001). There was also

found a significant association between microbiological analysis and the premise

hygiene score group (P<0.001). This study was found to have overall relationship

between microbiological findings of selected food examination and the hygiene score

of food premises.

Summary of the study: INSIGHT AND ATTITUDE TOWARDS ILLNESS IN RELATION TO THE RELAPSE RATE AMONG SCHIZOPHRENIC PATIENTS IN HOSPITAL UNIVERSITI SAINS MALAYSIA AND HOSPITAL KOTA BHARU Assoc. Prof. Hasanah Che Ismail/Mrs Radziah Mohd Fauzi

Background:

Schizophrenia is serious mental illness which has detrimental effect on individuals’

social and cognitive function especially those who are at chronic stages. Lack of

insight in schizophrenia has been increasingly in focus. It was frequently reported

that schizophrenic patients have poor insight and negative attitude towards their

illness. Several rating scales were developed to measure the insight in relation to the

different important aspects. The purpose of this study is to identify the relationship

between relapse rate of schizophrenic patients and their level of insight and attitude

towards the illness and treatment. The relationship of relapse rate and patients’

sociodemographic and clinical characteristics were also analysed.

Methods:

This cross-sectional study was conducted in Hospital Universiti Sains Malaysia and

Hospital Kota Bharu on a total number of 409 schizophrenic patients who were in

stable condition. Various aspects of insight towards illness, need for treatment and

attribution of the symptoms were assessed with our new scale: Insight and Attitude

Scale of Schizophrenia (IASS). IASS which has been validated and reliability tested

in the study population was used to measure the patients’ insight and attitude. The

measurement of insight has been based on this new self-administered questionnaire.

The patients aged from 16 to 60 years old without previous medical illness such as

epilepsy, dementia and cerebral vascular disease were included in the study. The

relapse data were obtained from patients’ medical records and patients’ or family

retrospective reports.

Results:

Insight and Attitude Scale of Schizophrenia (IASS) is a quick and acceptable

measure for insight among our population with the evidence provided. The study

result revealed the inclusion of male and female patients are of similar proportion and

the overall mean age is 32.2 years. The mean age of onset was 21.9 year old.

Slightly more patients (59.9%) received typical antipsychotic than atypical

antipsychotic drugs. There were 61.1% of patients who have low insight while 46.6%

have negative attitude towards their illness and treatment. The results also showed

173 patients (42.3%) or about two fifth of the patients had high relapse rate. Multiple

logistic regression analysis revealed significant association (p=0.019) between the

relapse rate and insight while adjusting gender, antipsychotic drugs and age at first

onset of mental illness variables. Nevertheless, there was no significant relationship

(p=0.857) between attitude towards illness and treatment with the relapse rate.

Conclusions:

The result found that majority of patients has poor insight and negative attitude

towards their illness and treatment. Our finding highlights the importance of

increasing the schizophrenic patients' insight in order to decrease relapse rate like

other previous studies. The study on the relationship of insight and patient’s attitude

and the relapse rate provides important information for understanding the causes of

relapse and enhancing the treatment of schizophrenia. Better understanding of

insight is probably crucial to program designed to decrease relapse and

rehospitalization among schizophrenic patients in our population. Our results

indicate that schizophrenic patients with low insight score were more likely to have

more relapse than those patients with high insight score. This study is consistent

with previous report by Heinrichs et al.,(1985) and Cuesta & Peralta (1994). Future

research might be necessary to examine the relationship between insight and

treatment compliance, neuropsychological deficit, family environment and other

factors that might influence the relapse rate among schizophrenic patient in the

population.

Key words: schizophrenia, insight, attitude, relapse and scale.

USM Short Term Title: THE EFFECTS OF TOCOTRIENOL (PALM VITEE) SUPPLEMENTATION ON EXERCISE-INDUCED LIPID PEROXIDATION AND ENDURANCE PERFORMANCE IN THE HEAT.

Professor Harbindar Jeet Singh, Dr. Chen Chee Keong

The purpose of this study was to investigate the effects of Palm Vitee

supplementation on exercise-induced lipid peroxidation and endurance

performance in the heat. 18 healthy, male recreational athletes completed two

endurance running trials until exhaustion on a motorized treadmill at 70% VO2max

on two separate occasions following a 6-week supplementation of either Palm Vitee

(PV) or placebo (PLA). Both trials were conducted in the heat (31oC, 70% relative

humidity). During the trials, rectal temperature(Trec), heart rate (HR), ratings of

perceived exertion (RPE) and oxygen uptake (VO2) were recorded. Blood samples

were collected for the determination of plasma volume changes (PVC), lactate (LAC),

glucose (GLU), malondialdehyde (MDA), creatine kinase (CK), total antioxidant

status (TAS) and vitamin E. No significant differences were evident in Trec, HR,

RPE, VO2 or in the time to exhaustion between the PV and PLA trials. Similarly,

PVC, CK, LAC, GLU and TAS were also not different between the two trials. Resting

plasma MDA concentration in the PV trial was significantly lower than that in the PLA

trial. At exhaustion, plasma MDA was higher than the resting values in both trials

and it was higher in the PLA trial compared to the PV trial. Palm Vitee

supplementation decreased lipid peroxidation at rest and, to some extent, during

exercise in the heat as evident from the lower MDA levels. It however, does not

enhance endurance running performance or prevent exercise-induced muscle

damage during exercise in the heat.

Title: Localization of the spinal nucleus of accessory nerve in the albino rat Prof. Madya Muzammil Ullah, Principal investigator, USM Short term grant Names of Co-investigators: Prof. Othman Mansor, Dr. Zul Izhar Mohd. Ismail SUMMARY The Spinal nucleus of accessory nerve (SNA, hereafter) is the group or groups of

motor neuron somata that supply the sternocleidomastoid (SCM) and trapezius

(TRAP) muscles. In the present study, the SNA has been localized in albino rat.

20 Sprague-Dawley rats (12 males, 8 females) were used in the study.

The animals were divided into two groups:

- Group-I ( included 15 rats)

- Group-II (included 5 rats)

In Group-I, the SNA was localized by retrograde axonal transport of HRP

(Horseradish peroxidase) technique. In Group II, the SNA was localised by

Retrograde degeneration technique using Thionine as stain for Nissl granules.

CONCLUSIONS: As a result of this study, the following conclusions were drawn:

1. Longitudinally, the SNA is located in the caudal part (caudal 0.9 to 1.2 mm)

of Medulla oblongata, the whole lengths of cervical spinal cord segments C-1, C-2,

C-3, C-4 and C-5 and the rostral-fourth of C-6.

2. In the caudal part of the Medulla oblongata, the SNA is represented by one

group of neuron somata lying immediately ventral (or ventrolateral) to the pyramidal

fibres that pass laterally (or dorsolaterally) after their decussation.

3. In the spinal cord, the neuron somata of SNA are located in two longitudinal

cell columns (DM & CEN) at C-1, three longitudinal cell columns (Dorsomedial or

DM, Central or CEN & Ventrolateral or VL) at C-2 and in only one longitudinal cell

column (VL) at C-3, C-4, C-5 and rostral-fourth of C-6.

4. The motor neuron somata supplying the sternocleidomastoid (SCM) are

located in the caudal part (caudal 0.9 to 1.2 mm) of medulla oblongata immediately

ventral (or ventrolateral) to the pyramidal fibres that pass laterally (or dorsolaterally)

after their decussation. They are also located in DM and CEN columns at C-1, in DM,

CEN & VL columns at C-2 and in VL column in rostral three-fourths of C-3.

5. The motor neuron somata of Trapezius (TRAP) are located only in the

ventrolateral column of ventral grey horn in the caudal three-fourths of C-2, the whole

lengths of C-3, C-4 & C-5 and the rostral fourth of C-6.

Title: SPECIFIC TESTS TO PROFILE SEPAK TAKRAW PLAYERS

- Prof. Rabindarjeet Singh -

Objectives: Anthropometric and physiological profiles of sepak takraw players were

determined.

Methods: Thirty-nine players, specialising in the three playing positions

(tekong/server, feeder, and killer/spiker), were divided into three age categories of

under 15 (U15), under 18 (U18) and under 23 (U23) years. Height, weight, percent

body fat [%bf], VO2max, range of motion (ROM), back and leg strength, and heart

rates, for the estimation of oxygen consumption during matches, were recorded.

Statistical analysis was performed using one-way ANOVA for independent

measurements and data are presented as mean ± SD.

Results: The U23 players were significantly taller and heavier with significantly

better ROM of the neck, trunk and ankle joints and back and leg strength than the

U15 players. No significant difference was found in %bf between the three age

categories. Mean maximal heart rate during exercise was significantly higher in the

U15 group when compared to the U18 and U23 groups (p<0.05). Mean VO2max was

not different between the three groups. Estimated oxygen consumption during

matches was 69.1, 68.5 and 56.4% of VO2max in the killer, tekong and the feeder

respectively.

Conclusions: Mean height, body weight and cardiopulmonary capacities of the

players were within the Malaysian population norms, but were somewhat lower than

players of other court games from other countries. %bf was also lower in these

players. This study provides the much needed anthropometric and physiological

data of sepak takraw players for further development of this sport.

Title : Rehydration with Sodium Enriched Coconut Water After Excercise Induced Dehydration

Prof. Rabindarjeet Singh, USM Short Term

The effectiveness of sodium enriched young coconut water (SCW) sports drink (SD),

young coconut water (CW) and plain water (PW) on whole body rehydration (R) and

plasma volume (PV) restoration after exercise-induced dehydration was assessed in

a cross-over study. Ten healthy male subjects (age range, 19 – 27 years) exercised

at 65% of VO2max at an environmental temperature of 32.06±0.02°C which a

relative humidity (RH) of 53.3±0.2% for 90 minutes and lost 3.1± 0.1% (1.8±0.1 kg) of

their body weight (BW). After which, the subjects moved to the thermoneutral

environment (23.2±0.3°C) and rested for 30 minutes prior to begin the 2-hour R

period. Subjects drank either SCW, SD, CW or PW representing 120% of the fluid

lost in three boluses representation 50% (915±54 ml), 40% (732± 37ml) and 30%

(556±35 mL) of the fluid lost at 0, 30, 60-min respectively. In the entire trials subject

were somewhat hypohydrated (range 0.32 – 0.52 kg below euhydrated BW) after the

2-h R period. The percent BW loss that was regained (used as index of percent

rehydration) during SCW, SD, CW and PW was 69±1%, 68±2%, 65±2% and 58±2%

respectively with a significantly (p<0.05) better rehydration with SCW and SD than

PW. The rehydration index (RI) for SCW and SD was significantly lower (p<0.01)

than PW. PV was restored similarly to euhydration levels after 2-h of rehydration

with SCW, SD and CW but was significantly lower (p<0.05) with PW trials.

Cumulative urine output was significantly higher (p<0.05) for PW when compare to

SCW and SD. Serum Na+ , serum K+ and urine osmolality of PW trial was

significantly lower (p<0.05) than SCW, SD and CW trial at the end of 2-hour R period.

Serum Cl- were significantly higher (p<0.05) with SCW and CW trials. Plasma

glucose concentration were significantly higher (p<0.01) when SCW, SD, and CW

were ingested compared to PW. SCW were similar in sweetness with SD and CW

but caused less nausea and stomach upset, furthermore SCW and CW were easier

to consume in large volume. In conclusion, ingesting SCW was as good as ingesting

a commercial sports drink for whole body rehydration after exercise-induced

dehydration but with better fluid tolerance.

TITLE : NEUROBEHAVIOURAL PERFORMANCES OF CAR SPRAY PAINTERS AND CAR MECHANICS EXPOSED TO ENVIRONMENTAL LEAD IN KOTA BHARU, KELANTAN

AUTHORS : ¹M.N. Mohd Nazhari, ²N. Rusli, ³A.K. Abu Hassan Shaari

INSTITUTION : ¹Tanah Merah District Health Office (MOH), ²School of Dental Sciences, Universiti Sains Malaysia, ³Kelantan State Health Department (MOH).

INTRODUCTION : Lead exposure posed a major public health issue and is

recognized as the most prevalent childhood health issue in most industrialized

countries, yet it is the most preventable (Dzulkifli, 1997). Lead-based painting

poisoning, a well-recognized entity among young children in poor, urban

neighborhoods, is not confined exclusively to such areas (P.E. Marino et al, 1990).

Worldwide, there are about 830,000 yearly deaths through illness linked to exhaust

fumes and industrial smog which engulfed many cities of the Third World. In Latin

America alone the figure stands at 115,000. In many parts of Asia, Africa and

Eastern Europe, the fumes are loaded with heavy metal such as lead (Dzulkifli,

1997). Most accurate estimates of health risks induced by lead can be obtained from

good history of blood lead measurements (T. Kovala et al, 1997). Level of lead in air

consequently lead to contamination of soil, water and food and subsequently

increased the exposure of future generations (WHO, 2000). The ideal blood lead

level is 0 �g/dl.

OBJECTIVE : To investigate the neurobehavioural performances of car spray

painters and mechanics exposed to environmental lead from lead-based pain

METHODOLOGY : This is a cross-sectional comparative study involving 44 car

spray painters exposed to lead chromate in car paint compared to 44 car mechanics,

car spray painting and servicing premises in Kota Bharu.

Assessment of exposure and outcome were based on 1) symptoms of neurotoxicity

obtained via the WHO standard questionnaire form 2) signs of neurotoxicity obtained

via WHO standard examination form 3) blood lead level checked as possible

exposure 4) neurobehavioural performance tested using WHO NCTB, and 5)

environmental lead level

RESULTS : Symptoms of lethargy, sleepiness, sudden awakening at night,

forgetfuness, stress, confusion, irritability, headache, vertigo, palpitation, excessive

sweating and numbness were noted more when there was a high level of blood lead

and recognized among car spray painters and were mechanics. Mean blood lead

level among car spray painters is 10.19 µg/dl compared to car mechanics of 7.39

µg/dl. Mean environmental lead level inside spraying booth is 8.07 µg Pb/m³ and

slightly lower than at servicing area which is 8.58 µg Pb/m³.

DISCUSSION : There is a significant difference in the mean blood lead levels

between car spray painters and mechanics. However, neurobehavioural symptoms

and NCTB results show no significant different between the groups. Also noted mean

blood lead levels of car spray painters and mechanics are higher as compared to

other groups of occupation in Malaysia.